Facility Evaluation Report

On 12/15/2025, Licensing Program Analyst (LPA) Daiquiri Boyd arrived at the facility unannounced to conduct a required annual visit. LPA was granted entry by caregiver staff. LPA explained the purpose of the visit and staff called the Administrator(AD), Pardeep Singh.

The residence was set at 75 degrees F temperature and free of passageway obstructions inside and outside. LPA observed six bedrooms in the residence. Residents' rooms were toured and inspected. Rooms were found to be clean, and furnishing was in good condition. AD and LPA discussed a sofa that was in a resident's bedroom that was provided by the family. AD and LPA discussed dementia clients and supervision as is needed. Hot water temperature was measured at 113 and 110 degrees F. Medications were observed locked in a closet off of the kitchen area.

Kitchen toured, supply of food observed, and food stored properly for perishable and nonperishable. Medications are locked next to the kitchen. Sharps and knives are locked in the kitchen area. Cleaning supplies were locked under kitchen sink. Smoke detectors and carbon monoxide were checked and operating. Fire extinguisher was new and purchased on 07/17/2025. There was outdoor seating for the residents. Outdoor area was clean and free of obstruction. Backyard gate connecting to the front driveway closes properly

Emergency and Disaster Plan was observed on the wall of the facility. During the visit a file review was conducted for residents and staff files.

An exit interview was conducted, and a copy of this report was provided to AD whose signature confirms receipt.

LPA requested the following updated forms faxed to CCLD by 12/29/25: Designation of Facility Responsibility (LIC308), Proof of current Liability Coverage, and administrator certificate.